May 18, 2009

I spend a lot of time talking to people who disagree with me – I could go as far as to say that it’s my favourite leisure activity – and repeatedly I meet individuals who are eager to share their views on science despite the fact that they have never done an experiment. They have never tested an idea for themselves, using their own hands; or seen the results of that test, using their own eyes; and they have never thought carefully about what those results mean for the idea they are testing, using their own brain. To these people, ‘science’ is a monolith, a mystery, and an authority, rather than a method.

In Bad Science, Ben Goldacre does two things: first, he explains how the scientific method works, and he does so in a simple, accessible and enjoyable way. And secondly, he denounced how the concept of ‘science’ keeps being distorted: by the press, by drug companies, by individuals trying to make money or push their own agendas. Goldacre is a British doctor, so the examples he uses are mostly UK-based and about health, but the ideas in this book are applicable to all sorts of fields of scientific knowledge and cultural contexts.

One of the most important ideas presented in this book is that science is a method, not a power game nor a system of belief. It has, of course, been appropriated by those who mean to use it to reinforce their power, but when that happens, we are entering the field of bad science. As any other method, science has rules, and those rules are not established arbitrarily with the intention of excluding anyone. They exist because they work, and there are very concrete reasons why they work.

Testability, clinical trials, randomization, control groups, representative samples, statistical significance, peer revisions, meta-analysis, you name it: Ben Goldacre explains it all in a way that anyone can understand. Actually, that too is part of his point: the scientific method is accessible. Anyone can understand it, and anyone can perform simple experiments. Likewise, anyone can spot a dubious experiment. The idea that science is out of the reach of mere mortals is one of the ways in which it keeps being distorted.

Also very important, he explains why: why all of this stuff matters, why we need it, why it’s used, and why studies with methodological flaws cannot be trusted. It’s not a matter of nitpicking – or rather, it is, but this kind of nitpicking is healthy and desirable, and it’s thanks to it that we know as much as we do today.

Reading Bad Science reminded me of my research methodology classes, which were taught by one of the best teachers I’ve ever read. In addition to how science works, he taught us think critically. And that too is the aim of this book. I have to admit that in my case, Ben Goldacre was preaching to the choir a little bit, because I’m a sceptic and I’m prone to being suspicious of pretty much everything. But no matter how you feel about science and health and alternative therapies, read this book. You will not be bullied into changing your mind. You’ll be given very concrete information that will hopefully allow you to make more informed decisions.

But I don’t want to give you the impression that Bad Science puts traditional medicine up against alternative therapies and explains why one is superior to the other. That’s not the case at all. Ben Goldacre writes about big drug companies, about nutritionists, about homoeopaths, about conventional doctors, about doctors-who-are-not-quite-doctors, you name it: about anyone who uses dodgy methods or makes questionable claims, really.

Another important point is that even though Goldacre can be sarcastic (hilariously, deliciously so), Bad Science is not an unkind book. It will not make anyone feel stupid or unwelcome or inadequate. It doesn’t mock or belittle people for believing the things they believe. There is, in fact, a chapter entitled “why clever people believe stupid things”, which explains the several cognitive process that can lead to wrong conclusions we are all prone to.

And why does any of this matter, you ask? Because in many cases it’s a matter of life and death. The chapter “The Doctor Will Sue You Now” (new in the paperback edition because Goldacre was stopped from publishing it before) is about how millions of people are dying of AIDS in Africa and being advised to treat it with vitamins rather than conventional medication. It’s so horrifying it literally made me cry. And a well-known example: Dr. Benjamin Spock’s well-meaning but untested advice that babies should sleep on their bellies led to thousands of cot deaths. This is why knowledge is important. This is why we need to follow the method.

Ben Goldacre also denounces (and how I love him for it!) what he calls the “medicalisation of everyday life”, and the increasing tendency to present pills as solutions for complex social problems. If you’ve been reading this blog for a while, you’ll know that this is a topic I care about passionately.

Another favourite chapter of mine was the one about how the press contributes to misinforming people about science. This is now it usually goes:

The scientific content of stories – the actual experimental evidence – is brushed over and replaced with didactic statements from authority figures on either side of the debate, which contributes to a pervasive sense that scientific advice is somehow arbitrary, and predicated upon a social role – the ‘expert’ – rather than on transparent and readily understandable empirical evidence.

This whole idea that scientific knowledge is a form of bogus authority that simply feeds on itself is unfortunately very common. And like I was saying before, that does happen. But when it does, we aren’t really dealing with science, but rather with its misuse.

Ben Goldacre is my new hero. Everyone should read this book. Not so that you can be persuaded to take one position or the other, but because there is information here that everyone should have. Also, it’s fun! Really, it is. Ben Goldacre is extremely funny and an excellent writer. I found this book impossible to put down - so much so that I completely neglected the also very gripping Wicked Lovely until I was done with it.

More awesome bits:

Because they cannot find new treatments for the diseases we already have, the pill companies instead invent new diseases for the treatments they already have. Recent favourites include Social Anxiety Disorder (a new use for SSRI drugs), Female Sexual Dysfunction (a new use for Viagra in women), night eating syndrome (SSRIs again), and so on: problems, in a real sense, but perhaps not necessarily the stuff of pills, and perhaps not best conceived of in reductionist biomedical terms. In fact, reframing intelligence, loss of libido, shyness and tiredness as medical pill problems could be considered crass, exploitative, and frankly disempowering.

In the aggregate, these ‘breakthrough’ stories sell the idea that science—and indeed the whole empirical world view – is only about tenuous, new, hotly contested data and spectacular breakthroughs. This reinforces one of the key humanities graduates’ parodies of science: as well as being irrelevant boffinry, science is temporary, changeable, constantly revising itself, like a transient fad. Scientific findings, the argument goes, are therefore dismissible.

How do the media work around their inability to deliver scientific evidence? Often they use authority figures, the very antithesis of what science is about, as if they were priests, or politicians, or parent figures. ‘Scientists today said…Scientists revealed… Scientists warned.’ If they want balance, you’ll get two scientists disagreeing, although with no explanation of why (an approach which can be seen at its most dangerous in the myth that scientist were ‘divided’ over the safety of the MMR). One scientist will ‘reveal’ something, and then another will ‘challenge’ it. A bit like Jedi knights.

(Have you posted about this book? Let me know and I’ll be glad to add your link here.)I'm so sorry! I should have announced this last week, but I completely forgot. The winner of the copy of The Fox Woman I was giving away is Paperback Reader. Congratulations! E-mail me your address and I'll send the book your way as soon as possible.

Amanda: Ooops - thanks to the picture, the indenting didn't really show, so I edited it and made it italics so that it's clear it's an excerpt. I suppose Goldacre does it because he's fighting for something he believes in: that science shouldn't be so widely misrepresented. Me, I avoid confrontation like the plague :P I'm way too non-confrontative, actually. Sometimes I bite my tongue when I really ought to speak up.

Oh how I want this book!!!!!! Of course, he'll be preaching to the choir here, too, but the choir will mightily enjoy the sermon. ;) Thanks, Nymeth, for this totally irresistible review!

And you want to hear something funny...my very favorite professor was undoubtedly my research methods teacher. In fact, as pathetic as it makes me sound, after all this time, he's the only one I can even remember his name off the top of my head.

This sounds like a great read. I am glad someone has come out with a book that explains why science is so important to us in a style that everyone can understand. I like the part about creating new diseases. I have thought this for a long time. The commercials for medicine on TV are creating a lot of hypocondriacs, too: "Take this pill if you sometimes have trouble going to sleep after consuming large quantities of caffeine." Or something similarly ridiculous. I mean, who doesn't?

Amanda: lol, no problem :P It's that I formatted the post last night and set it to auto-post today. In preview mode the indenting showed, but not after it was actually posted.

bermudaonion: lol, I went on and on about it to my boyfriend. It's just so full of interesting facts and examples!

Literary Feline: Exactly!

Holly: This definitely makes science sound very appealing! I think how much we like science really does have a lot to do with the way it's taught.

Debi: Yep, the choir will definitely enjoy the sermon :D And hooray for awesome research methods teachers! Seriously, I owe mine so much.

Care: "AWESOME" pretty much sums up my reaction to this book :D

Scrap Girl: Unfortunately I do think that goes on a lot :/ I mean, those problems are real and serious, but they have too many causes, and those causes are too complex for a pill to be able to fix them. And even if medication does treat the symptoms of say, social anxiety, the root causes are still going to be there.

Rebecca: Exactly...who doesn't? He talks about how there's a difference between the UK and the US because in the UK it's illegal for drug companies to advertise to the general public directly. So instead, they target doctors. Slightly different methods, but same general problems.

I think this is a book I really ought to read. My husband is always telling me about how things are skewed and the info presented to us in news, etc. isn't what's really going on. But usually when he tries to explain why to me I just get confused.

This looks sooo fascinating! I am curious about what he has to say regarding pills for social/mental problems - it's something I think about a lot. And just in general I feel like I struggle to understand science. Thanks for the recommendation!

So this is a book that I NEVER would've read if not for your review! I can't wait to read this now. I've been looking forward to this review ever since you first mentioned it (on twitter I think?) This really does sound like an important book. that's so sad about the AIDS patients in Africa :( It astounds me that some people can say such horrible things. I may have stones thrown at me for this, but one thing I can't stand is when people replace medicine with prayer. I'm not saying that prayer isn't helpful for some people, but I've heard stories of people dying because they refused treatment for things like cancer because prayer would cure it...ok, I'm getting off my soapbox now before people stop reading my blog :/

I am not a "science" person but what attracts me to this book is the last part you mentioned. The whole, "let's give people a pill for something" mentality. Medicine is wonderful but so are other more natural approaches. And, of course that not everything in life needs a pill! I may not rush out to read this book but thanks to your review I'll think about it.

Jeane: There's a great chapter about how the way journalists choose to present numbers really distorts how the public perceives them, even if they don't actually lie. He explains it so well!

Staci, definitely a very important book.

Jenny: I always struggled too until that awesome teacher came along. I think part of the problem is that we're told "this works like this", but it's only rarely that we're explained WHY. And that makes all the difference.

Chris: lol, no one will stop reading your blog. You're absolutely right - nothing against prayer, but I don't think it's wise to make it your sole bet. The guy he talks about in the book is one of those who deny AIDs, who claims it's all a Western plot to gain control over the rest of the world. And as Goldacre explains, people in developing countries actually have very good reasons to be quick to assume that...especially with western drug companies unwilling cut the prices of drugs, and yet spending millions on advertising...gah, it's all a HUGE mess. And SO many people are infected :/

Violet: I know it sounds like it, but it's actually not heavy reading at all! It was a page-turner.

Iliana: Yeah, I know... it just seems unreasonable to expect pills to solve problems whose causes are so often social. A lot of people are getting rich thanks to that trend, though :/

Debi told me to check out your review and I'm glad I did. I'm also glad she bought this book so I can read it!I loved the example of Dr. Spock and putting babies on their bellies. So many "experts" spout "expertise" without any data at all! And these people are scientists...In order to point out how this happens V.S. Ramachandran, the great author and neurologist who wrote "A brief tour of human consciousness", wrote an article entitled "Why gentlemen prefer blondes" and sent it to the Journal of Evolutionary Psychology. He proposed that blondes have fair skin and so suitors can better tell if they have parasitic infections...he had no data and was basically making it all up, but they offered to publish it! Thanks for a great review!

I think this looks amazing! Especially because you pointed out that it talks about creating conditions for existing drugs - when will the general population catch on to this madness. Also interesting to me is the over-prescribing of drugs for convenience. On the other hand I would be interested to see if it covers anything about doctors/pharmacists getting people to use different methods when a medication is being used already with positive results.

Gavin: I'm someone who manages to be both a science person and a humanities person. We might be rare, but we do exist :P

Naida: I'd never read anything of the kind before, but it's a much-needed book :)

Rich: It baffles me that so many people who work in science or in science-related jobs fail to grasp WHY backing up things with research is important! And that story is as funny as it is worrisome. It reminds me of the whole Sokal affair. How sad that an actual science journal would fall for that too! I've always been a bit suspicious of some of the claims of evolutionary psychologists, and it sounds like I should be.

Joanne: It doesn't deal with that, no, but wow, that's worrisome :/ At the same time, I'm not at all surprised to hear it happens. And yeah, I wish people in general were more aware of those tricks. It's all a matter of access to information, and books like this can help!